What is the recommended use and dosage of Cefdinir (Cefdinir) for treating bacterial infections?

Cefdinir: Recommended Use and Dosage for Bacterial Infections

Cefdinir is an oral third-generation cephalosporin antibiotic recommended for treating specific bacterial infections with a standard adult dose of 300 mg twice daily or 600 mg once daily, and pediatric dose of 14 mg/kg/day (divided once or twice daily) for 5-10 days depending on the infection type.

Indications and Spectrum of Activity

Cefdinir is FDA-approved for treating the following infections:

• Respiratory tract infections:

  • Community-acquired pneumonia
  • Acute bacterial exacerbations of chronic bronchitis
  • Acute maxillary sinusitis
  • Pharyngitis/tonsillitis
  • Acute bacterial otitis media

• Skin and skin structure infections:

  • Uncomplicated skin and skin structure infections

Cefdinir is active against the following pathogens 1:

• Gram-positive bacteria: Staphylococcus aureus (methicillin-susceptible strains only), Streptococcus pneumoniae (penicillin-susceptible strains only), Streptococcus pyogenes
• Gram-negative bacteria: Haemophilus influenzae, Haemophilus parainfluenzae, Moraxella catarrhalis

Dosage Recommendations

Adult and Adolescent Dosing:

• Standard dose: 300 mg twice daily or 600 mg once daily 1, 2
• Duration: 5-10 days depending on infection type
• Administration: May be taken without regard to meals

Pediatric Dosing (6 months through 12 years):

• Total daily dose: 14 mg/kg/day, up to maximum 600 mg per day 1
• Dosing frequency:
  • Once daily (14 mg/kg/day) or
  • Twice daily (7 mg/kg every 12 hours)
• Duration by infection type 1:
  • Acute bacterial otitis media: 5-10 days
  • Acute maxillary sinusitis: 10 days
  • Pharyngitis/tonsillitis: 5-10 days
  • Uncomplicated skin infections: 10 days (twice daily dosing only)

Dosage Adjustments for Special Populations:

Renal Impairment 1:

• For adults with creatinine clearance <30 mL/min: 300 mg once daily
• For pediatric patients with creatinine clearance <30 mL/min/1.73 m²: 7 mg/kg (up to 300 mg) once daily

Hemodialysis Patients 1:

• 300 mg or 7 mg/kg every other day
• Additional 300 mg or 7 mg/kg dose after each hemodialysis session

Clinical Role in Treatment Guidelines

Respiratory Infections

1. Community-Acquired Pneumonia:

   • In adults, cefdinir is listed as an alternative oral therapy for outpatient treatment of pneumococcal pneumonia 3
   • In children, cefdinir is recommended as an alternative for step-down oral therapy for pneumonia caused by susceptible S. pneumoniae 3

2. Acute Bacterial Rhinosinusitis:

   • For adults with mild disease and no recent antibiotic use: cefdinir is recommended as an alternative to first-line agents 3
   • For pediatric patients: cefdinir is recommended as an alternative to high-dose amoxicillin/clavulanate 3

3. Pharyngitis/Tonsillitis:

   • Effective alternative to penicillin for streptococcal pharyngitis 3, 4

Skin and Skin Structure Infections

• Cefdinir 300 mg twice daily for 10 days demonstrated equivalent efficacy to cephalexin 250 mg four times daily in uncomplicated skin infections 5
• Clinical cure rates for both methicillin-susceptible and methicillin-resistant S. aureus were approximately 90-93% 5

Advantages and Limitations

Advantages:

• Convenient once or twice daily dosing 2, 4
• Well-tolerated suspension with superior taste compared to other oral antibiotics 2
• Good tissue penetration in respiratory tract tissues and skin 2, 4
• Stable against many common beta-lactamases 6, 7

Limitations:

• Not active against Enterobacter species, Pseudomonas species, Enterococcus species, penicillin-resistant streptococci, or methicillin-resistant staphylococci 1
• Diarrhea is the most common adverse effect (reported in approximately 10% of patients) 5
• Not recommended for empiric treatment of infections with high risk of drug-resistant S. pneumoniae without susceptibility testing 3

Common Pitfalls and Practical Considerations

1. Drug Interactions:

   • Antacids containing aluminum or magnesium may decrease absorption of cefdinir
   • Iron supplements may reduce absorption; separate administration by 2 hours

2. Administration with Food:

   • While cefdinir can be taken without regard to meals, high-iron foods may reduce absorption

3. Duration of Treatment:

   • Complete the full prescribed course even if symptoms improve before completion

4. Resistance Concerns:

   • Not recommended as first-line therapy in areas with high prevalence of drug-resistant S. pneumoniae
   • Beta-lactamase negative, ampicillin-resistant H. influenzae strains are typically non-susceptible to cefdinir 1

5. Storage of Suspension:

   • After reconstitution, the suspension can be stored at room temperature for 10 days, after which any unused portion must be discarded 1

In summary, cefdinir is an effective oral cephalosporin for specific respiratory and skin infections with convenient dosing and good tolerability profile, particularly valuable in areas with high prevalence of beta-lactamase producing organisms.